Lobar strokes are usually due to what?
What are some conditions that mimic a stroke?
Space occupying lesion
Deep brain strokes are usually due to what?
Rupture of deep penetrating arteries
What is a semantic error of speech?
Mistake with word finding eg bus instead of train
What is a dysphasia?
Disorder of language
What are the new anticoagulants being used instead of warfarin?
What is the risk of haemorrhage while on anticoagulants?
1-1.5% per annum
How do you differentiate a TIA from a seizure?
Seizure will have positive signs as well eg jerks or tingling
According to the CHADS2 scoring system, when are oral anticoagulants indicated?
If hypertensive and >75 years of age or,
2 or more = Warfarin
How do you differentiate a TIA from a migraine?
All the symptoms will come on immediately with a TIA while they will progress more slowly with a migraine
What is a lacunar infarct?
Infarct result from occlusion of one of the deep penetrating arteries
What is the major difference between a stroke and TIA?
Permanent brain injury occurs in a stroke
When do you perform a carotid endarterectomy?
Generally if the stentosis is >50% or
If it produces symptoms
What percentage of strokes are intracerebral haemorrhages?
15% in Aus
What is a phemonic error of speech?
Error of the sound of a word eg last instead of past
What is the mechanism of action of Dabigatran?
Direct thrombin inhibitor
What is the CHADS2 score used for?
Assessing stroke risk for patients with non-valvular AF
What are the rates of recurrence in stroke patients?
5-10% within 1 week
10-20% within 3 months
What is the mechanism of action of Rivaroxaban?
Inhibitor of factor 10a
What is haemorrhagic transformation?
Haemorrhage post embolism in the setting of thrombolysis
What is the most common location for thrombotic occlusion in the brain?
When does cavitation start to occur post infarction?
After 7 to 10 days
What is lipohyalination?
Introduction of lipids into arterial walls, typically in deep perforating arteries that can lead to a HTN haemorrhage
Outline your approach to assessing a patient with stroke on physical exam?
ABCs - Particularly the gag reflex
- Localising the lesions using focal signs
What are some pathologies that mimic the presentation of a stroke?
Space occupying lesions
Venous sinus thrombosis
Metabolic: hyponatriaemia, hypo/hyperglycaemia, Wernicke's
What Ix would you perform in the acute setting for stroke?
Bloods - FBE, UEC, BSL, Coags, fasting blood lipids
CXR and CT brain (C-, angio, perfusion)
How do you approach the management of a patient with a stroke acutely?
Nil by mouth